Pericarditis is an acute or chronic infection of the pericardium causing a severe inflammation of the sac enclosing the heart and the bases of the great vessels.

Pericarditis can result from bacterial, fungal or viral infections; high-dose radiation to the chest; uremia; hypersensitivity or autoimmune diseases; drugs; idiopathic factors; complications of systemic conditions; trauma; tumor development; and mycoses. It may also result from the rheumatic fever process.

Acute pericarditis may cause severe chest pain in the front lower chest area that radiates to the neck, back, or shoulders, and to the arms. Pain intensifies when the patient lies on the back, coughs or breathes deeply or swallows. There may also be a grating sound as the heart moves (pericardial friction rubs). Other signs and symptoms may include: moderate fever, dry cough, dyspnea, anxiety, insomnia, palpitations, and a rapid and forcible pulse which becomes weak and irregular. Signs and symptoms of congestive heart failure (CHF) may also be present. Chronic constrictive pericarditis may show a systemic venous right ventricular failure, including fluid retention, ascites, and hepatomegaly. Electrocardiogram (EKG) changes will show diffuse elevation of sedimentation time (ST) segments without significant changes in QRS morphology.

The functional abilities of cardiac patients can be classified in terms of metabolic equivalents (METs). The classification is generally as follows:

• Light to medium housework is 2 to 4 METs

• Heavy housework or yard work is approximately 5 to 6 METs

• Strenuous activity would be 7 to 10 METs, etc.

To determine the limitations on patient's functional abilities, the METs are considered in accordance with what symptoms are exhibited when the activities are carried out. For example, if a patient is performing activity at the 2 to 4 MET level and experiences dyspnea, fatigue, dizziness or fainting, the patient is considered to have low functional abilities.

Laboratory results do not establish diagnosis. Blood tests, including a white blood count (WBC), erythrocyte sedimentation rate (ESR), blood urea nitrogen (BUN), and antistreptolysin O (ASO) titer; and a purified protein derivative (PPD) skin test may be done. Other tests include serial EKGs and echocardiography. A culture of pericardial fluid obtained by open surgical drainage or cardiocentesis may identify a causative organism.

The focus of treatments is to relieve symptoms and manage the accompanying systemic disease. Treatment includes complete bed rest as long as pain and fever persist, and nonsteroidal drugs. Some varieties of the condition require antibiotics, surgical drainage, or both. The potential also exists for a pericardiocentesis being performed.

Residuals will vary ranging from no residuals to any combination of the signs and symptoms. The person may experience chronic CHF.

• May be entitled to special monthly compensation where the Veteran has a single service-connected disability rated as 100% with additional service-connected disability or disabilities independently ratable at 60% or more, which are separate and distinct from the 100% service-connected disability and involves different anatomical segments or bodily systems. See  38 CFR 3.350(i)(1) – Special Monthly Compensation (SMC).

Notes

• Evaluate cor pulmonale, which is a form of secondary heart disease, as part of the pulmonary condition that causes it.

• One MET (metabolic equivalent) is the energy cost of standing quietly at rest and represents an oxygen uptake of 3.5 milliliters per kilogram of body weight per minute. When the level of METs at which breathlessness, fatigue, angina, dizziness, or syncope develops is required for evaluation, and a laboratory determination of METs by exercise testing cannot be done for medical reasons, a medical examiner may estimate the level of activity (expressed in METs and supported by specific examples, such as slow stair climbing or shoveling snow) that results in those symptoms.

• For this general formula, heart failure symptoms include, but are not limited to, breathlessness, fatigue, angina, dizziness, arrhythmia, palpitations, or syncope.

• The rating criteria for cardiovascular conditions underwent full-scale revision effective on November 14, 2021 and January 12, 1999.  A regulatory change was effective August 13, 1998, updated criteria for cold injury residuals under 38 CFR 4.104, DC 7122. The changes are not considered liberalizing and should not be used as the basis for reduction unless the disability has actually improved.